A case study of an adrenally fatigued,

nutrient-depleted professional athlete

Ian Craig

Ross – 28 year old Welterweight

Boxer

GOALS:

•Win a World Title Fight in

8 weeks

•Make weight (10 ½ stone)

easier

•Stop getting ill

Functional Analysis

INPUT• stress/anxiety

• snacky diet

• ibuprofen/antibiotic

DEFENCE

• recurrent infections

• pneumonia at 11

• diarrhoea

COMMUNICATION

• stressed

• tired

• low blood sugar

STRUCTURE• fractured rib

• inflamed knuckle

• diarrhoea

OUTPUT

• headaches

• diarrhoea

• fluctuating mood

Input

• Stress/anxiety (worry about weight; driving 2-

3hrs/day; training; selling tickets; hypercritical;

overcommitted)

• Obsessive personality – father alcoholic

• Ibuprofen for headaches and injuries

• Antibiotics in past for infections

• Food – snacky (eats in the car); moderate sugar and

caffeine content; drinks tap water

• Nutrients – Vit C, Iron, CLA, Vitabalance, Omega 3,

Glucosamine/Chondrotin, Whey, Fruit + Veg Blend

• Training – 3 hrs per day

Output

• Headaches related to stress and 2 migraines in his

life

• Diarrhoea – digestion is first to go when getting ill

• Fluctuating mood; feeling of hangover

• Grandfather had pancreatic cancer

• Mother had constipation

Defence

• Recurrent throat and chest infections – always

known it that way - much worse when training hard

• Pneumonia at age 11

• Digestive upsets

Communication

• Stressed

• Needs >9hrs sleep, tired in morning and afternoon

• Iron blood test low 2 yrs ago

• Low blood sugar; needs to eat frequently

• Dizzy when standing too quickly

Structure/Repair

• Fractured rib in last fight (a month ago)

• Right knuckle inflamed – recent steroid injection

• Twice daily training (muscle breakdown)

• Leaky gut?? Digestive upsets; fluctuating mood;

feeling of hangover

• Low pain threshold!

Training

• Gym – 5 days a week – 2 hours boxing

specific training

• Run – 6 days a week – 1 hour steady

• Weights – 2 days a week – strength,

plyometrics and some Olympic lifts

• Yoga – 1 day a week – just started

DIET

9am Apple juice; porridge, skimmed milk, honey & blueberries; green tea

10am Drive to training (1 hour)

11am Apple and pint water

11-1 Gym (+ 1l water + 1 ‘Go Bar’)

1.30 Black tea; brown bread (2 slice), butter and gammon; 8 strawberries

3.30 Nectarine

5pm ½ pint water + J2O drink

5-6 1 hour run

7pmWheat wrap with smoked mackerel, tomato, carrot and spinach; stick celery; green

tea with honey; biscuit

9pm10 king prawns; 2 handfuls spinach; fat-free fruit yoghurt; 5 strawberries; ½ pear; ¼

tin fruit cocktail

11.30 Sleep

Body Fat

10%

Height

170cm

Weight

73kg

Ragland

113/65 (42)

142/68 (49)

Zinc Taste

2 to 3

Barnes

Basal

temperature

Ave 35.9

Values

• I asked him to pull out the top Values in his life

from the areas of; Career, Spirituality, Family,

Personal growth, Health & fitness &

Relationships

• The top five were:

1. Love

2. Vitality

3. Success

4. Longevity

5. Self Worth

Steven’s Lean Body Mass

• Body Fat ~ 10% (estimated by Durnin and

Womersley)

• Weight = 73kg

• Fat Mass = 10% of 73kg = 7.3kg

• Lean Body Mass = 73 - 7.3 = 65.7kg

Steven’s Calorie

Expenditure

• Resting Metabolic Rate = 500 + (22 x 65.7) ~ 1945 Cals

• Daily Activity Levels = 40% of 1945 ~ 778 Cals

• Training in a week = ‣ 10 hrs at gym 5000 Cals

‣ 4-6 hrs jog 4000 Cals

‣ 2 hrs weights 900 Cals

‣ Total in week - about 10000 Cals

• Training per Day ~ 1400 Cals

Total Energy Expend = RER + Daily Activity + Training

= 1945 + 778 + 1400 = 4123 Cals

Cunningham (1980)

Steven’s Calorie Intake

• Based on 3 days of dietary analysis:

– Calories 2415 Cals (10,143 kJ)

– Carbs 264g (44%)

– Protein 127g (21%)

– Fat 94g (35%)

Adrenal Stress Index

“Exhaustion Stage:

This is generally a state of insufficient production

of adrenal hormones after multiple years of

persistent stressors with insufficient coping

mechanisms. Patients usually present with

fatigue, poor energy and immune system

hypofunction. They may exhibit chronic anxiety. In

some patients this represents impaired response

to shorter-term stressors.”

Secretary IgA

“Several studies link stress and emotionality with

levels of SIgA. Production is adversely affected by

stress, which is mediated by cortisol levels. This

could result in inadequate production of SIgA in

response to a mucosal infection.”

Nature of Stress

Let’s emphasise two points about the stress

response

1. It takes priority over all other metabolic

functions

2. It wasn’t designed to last very long

Infection

• Athletes who are overtrained may be more

susceptible to infections. Their immunoglobulin

levels may be decreased, especially IgA

• Cortisol has been shown to inhibit the activity of

NK cells and has anti-inflammation properties

including the suppression of histamine

• Proneness of infection has also been attributed to

a decrease in glutamine due to heavy training

Gilmore (2004); Kuipers (2000); O’Brien (1988)

Diet – Balancing Act

Challenge:

• supply macronutrient needs

for training, immune

and endocrine systems

• strip body fat to make weight

NEW DIET

On Rise 1 pint water with squeezed lemon

8.30B-fast - 3 eggs scrambled + 100ml SS milk + ½ avocado + 2 thin slices rye bread + a

tomato and a carrot

10.30 Pre-exercise – small handful mixed nuts plus a banana

11-1 Gym (+ 1l Sport drink – 60g glucose plus 20g whey)

1pm Post-exercise – 1l sports drink (30g glucose plus 20g soya/whey mix)

2pmLunch – 125g chicken + 30g brown rice + lettuce, tomato, cucumber, olives, onion,

20g cheese, ½ avocado

4.30Snack – Smoothie (125g natural yoghurt, 50g mixed berries, 1 tbsp 3-6-9 oil, 10g

whey plus a touch of water)

5-6 1 hour run

6.30Dinner – 125g salmon, 100g broccoli, 30g spinach, 60g carrots, 50g cauliflower, 50g

quinoa, 2 tbsp pumpkin seeds

9.30 Supper – 125g natural yoghurt, 50g blueberries, 1 tsp honey

10-10.30 Sleep

Steven’s New Calorie

Intake

Based on computer analysis of diet:

– Calories 3323 Cals (13,957 kJ)

– Carbs 300g (36%)

– Protein 197g (24%)

– Fat 146g (40%)

Lifestyle Recommendations

• Delegate – it seems to me that you like to take charge of things. I suggest that you let others help you out.

• Don’t drive any more than you have to – it is a stress load on the body.

• Routine routine – it seems to make you thrive, so stick with it at least for this period. Have a planned, monotonous day for a while.

• Yoga – do 1 session per week and focus on letting your tension go to get into the stretches. Also, use the yoga breathing for at least 15-20min per day to create a state of calm.

Supplements

• Multivit, high in chromium, B-vits, antioxidants

• Vitamin C – 1g bid

• Hemp oil – 2 tbsp on food• Oil – EPA/DHA/GLA blend – 1 tsp bid

• Probiotic (24 billion microrganisms per cap) – 1 bid

• L-glutamine powder – 5g per day• Phophatidylserine – 200mg post-exercise

• L-tyrosine – 500mg before exercise and mid-afternoon

• Whey – post-exercise nutrition and in afternoon smoothie

• Fruit and Veg Concentrate – in smoothie

• Epson salt baths – 2-3 cups Epson salts in a bath 3-4 times a week before bed

Glucose-

Alanine Cycle

Wagenmakers (2000)

Phosphatidylserine

• Phosphatidylserine (PS) is a phosholipid found in all cells, making up about 70% of nervous tissue

• It aids in the activity of NT’s and their receptors and is involved in cell-to-cell communication

• It stimulates the release of dopamine, increases production of acetylcholine, enhances brain glucose metabolism and boosts the activity of nerve growth factor

• PS has been shown to significantly blunt the responses of stress hormones (including ACTH and cortisol) to physical exercise, without affecting the rise in GH and prolactin

LE Magazine (2002)

External oblique enthesopathy - fluid / tissue stress in the space at the attachment

of the muscle to the rib

Additional supplement advice

for injury

• Anti-inflammatory product - curcumin, boswellia, green tea, ginger, rosemary, celery, alpha-lipoid acid, resveratrol – 4 caps 3 X day with food

• Digestive enzyme product - when taken on an empty stomach, the enzymes are able to digest inflammatory debris from an injury site and speed up recovery – 6 caps 2 X day on empty stomach

Visit 2 (3 months later)

Changes

• Eating pretty much the way I had recommended

and maintaining weight despite the lack of

training

• Taking supplements as suggested

• Energy is fine for training

• Moved to London during the week to avoid daily

commutes to gym

• Agreed to run more elaborate tests to work

towards more optimal health

• Hoping for world title fight in 2-3 months time

Testing

Organic acids

and

Amino acids

Organic acids interpretations

• One yeast/fungal dysbiosis marker

borderline high

• Low adrenal catecholamine

neurotransmitter levels, supporting the

independent measure of adrenal

exhaustion

• Fumarate in the Krebs cycle low

Amino acids interpretations

• Histidine and essential amino acids are

deficient – consider gastric hypochlorhydria

• Tyrosine is deficient - consider thyroid

insufficiency, adrenal medullary dysfunction

or subnormal levels of adrenal

catecholamines with possible dopaminergic

dysfunction

Adjustments in recommendations

• To keep working on the diet as he had been

• To keep working on stress management

strategies, potentially working with somebody

like a Neuro Linguistic Programming (NLP) or

Cognitive Behavioural Therapy (CBT)

practitioner

Revised supplements

• Multivit, high in chromium, B-vits, antioxidants

• Vitamin C (supportive to adrenals and immune system)

• P5P (active form of B6) for neurotransmitter conversion

• Digestive enzyme (to increase amino acid absorption)

• Amino acid broad spectrum product (to increase aminos in

body)

• Saccharomyces boulardii (anti-fungal)

• Phophatidylserine (to calm the mind)

• Oil – EPA/DHA/GLA blend

• Probiotic (24 billion microrganisms per cap)

• L-glutamine powder

• Nighttime sleep snack for GH production

• Epson Salt Baths

The taper

• He had already lost 1-2 kg with the revised diet, so had

about 5kg to drop for weigh-in

• Two weeks before the fight, we restricted his dietary

carb intake, but kept his drinks and snacks around

training

• One week before the fight, with the taper in training, we

also dropped the drinks and snacks

• Two days before weigh-in, he weighed 3kg above

weigh-in weight

• The night before, he restricted water intake and ran in

his sweat suit and took a sweat bath and comfortably

dropped the 3kg

The re-load

• He had 32 hours between the Friday noon weigh-in and

the Saturday 8pm fight

• We had 2 lunch, 2 dinner, 1 breakfast and 3 snack

opportunities to load him with 5870 Cals of food and

about 6 litres of fluid (with electrolytes)

• He entered the ring weighing 75kg (8kg more than the

day before)

TIPS FOR THE TAPER

Work down to a lean body composition during the months before the fight

Strengthen adrenal and immune strength in the months before to cope with the harsh

regime

Within two weeks of the fight, tighten in on the carb consumption to the point that you start

losing body fat, or whatever other technique works genetically for you

2 days before the fight, if you still need to lose weight, start water fasting but only under

experienced supervision

After weigh-in, have a carb- and water-load strategy ready to rebuild as quickly as

possible. Take plenty of rest at this time.

References

• Cunningham (1980). A reanalysis of the factors influencing basal

metabolic rate in normal adults. Am J Clin Nutr. 33:2372-2374.

• Gilmore (2004). Overtraining – its effect on the endocrine system.

Lecture Notes – University of Glasgow.

• Kuipers (2000). Overtraining: Nutritional Intervention. Chapter 37.

Nutrition in Sport. The Encyclopaedia of Sports Medicine (IOC

Publication). Blackwell Science

• LE Magaxine (2002). Phosphatidylserine (PS) the essential brain

nutrient. LE Magazine

http://www.lef.org/magazine/mag2002/sep2002_report_ps_01.html

(accessed March 2007)

• O’Brien (1988). Overtraining and sports psychology. The Olympic

Book of Sports Medicine – An International Olympic Committee

Publication. Blackwell Scientific Publications.

• Wagenmakers (2000). Amino acid metabolism in exercise. Chapter

9 – Nutrition in Sport. Edited by Maughan. Blackwell Science Ltd.

Queensbury Boxing

• Ross Minter is now a boxing promoter and a

personal boxing coach

• View www.queensburyboxing.co.uk for

upcoming shows